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Exactly. If you are a Canadian citizen you have the responsibility to respect the Canadian tradition of honouring those who have chosen to serve Canada. It really is that simple. At what point do we tolerate ourselves out of existence? Race, religion, sexual preference, political views, I could care less. Do not disrespect those who serve the country. If you don't like the way soldiers are deployed protest those government policies. Soldiers don't choose where they're deployed. Politicians do.

One of my frustrations as an EMT working a rural BLS service is the lack of pain medication I can provide. I feel that a medic can provide far superior care in a lot of situations that I find myself in (hence one of the reasons I am currently in paramedic school). Do I think that basics should be able to provide more meds? No. Anyone working in the medical field should have a thorough education to know the anatomy and physiology, pathophysiology involved, and risks and benefits of the medication before giving it. For example, not that long ago, I had a call for a 24yo male who had a leg caught in a piece of machinery.. he was in excruciating pain, and the only pain med I am allowed to give is Entonox (nitrous oxide) which really wasn’t enough in this situation. After a 15 minute extrication, and 25 minutes to hospital, this poor guy had been in pain for a long time. Since pain can increase shock, by not trying to control this guy’s pain, I am really not helping him as well as I could, since I cannot control his shock well either. ALS was over an hour away, so my only hope for pain control was to get him to the hospital. Did I do as much as I could for that patient? Absolutely, as I did all I could within my scope of practice. Was it enough? Absolutely not. I am not advocating handing out pain meds like a Pez dispenser. I am advocating providing pain medication as part of a thorough treatment, after a thorough assessment and history is obtained. Pain control is as much a part of patient care as holding a hand, or consoling a patient, or providing airway management or fluid resuscitation. It is part of what we should be doing. Dwayne said it so well when he said “Every patient has a right to have an ambulance come to them. Every patient has a right to a professional, thorough assessment, and every patient has a right to complete and competent treatment based on that assessment up to and including emotional support and pain management.”

I believe that pain management is one of our most important tools, and one that is very much under used. And of course I don't believe that basics should have access to narcs/benzos. One of the things that makes me batshit crazy is to listen to the yahoos talk about how they're able to 'spot a drug seeker' a mile away. Bullshit. I've even heard them talk about withholding pain management for their drug seekers that they truly believe are now in pain, based on the patients previous history. Man, this is one of the best reasons to increase educational standards for EMS. Perhaps is those folks have their knowledge to be proud of then they won't need to attempt to show their 'specialness' by showing how callus they are because of all of their 'experience. I believe that my job is to provide physical, physiological, and emotional support when possible. And though I don't often share their beliefs I certainly find no need to interfere with their spiritual beliefs either and am happy to find such support for them when I can. Have I given narcotics to a known drug seeker? Probably, but often I haven't, not because I believed them to be seekers, but because the list of symptoms that they chose to give me to fulfill their needs lead me to believe that narcotics weren't prudent until after a physician level exam. Ladies and gentlemen!! Drug seeking is a symptom! Because you happen to believe that these people should not have interupted your tv show with their silly symptom doesn't mean that they deserve less professional care! Thank you for listening. To our newer and younger providers. You will be awash in shitheads that are going to try and convince you that you haven't made your bones until you have proved that you are tough enough and experienced enough to deny proper care to those that you don't feel deserve it. Sounds crazy, I know, but most here I believe will back me up on that. Should you choose to join that club I'd ask this simple thing. Turn over the card that your certification came printed on, and in a Sharpy marker write, "This certification no longer applies to me. I have decided to become one of the wanker shitheads. I have earned the right to wear the patch, and my hero Tshirts, but I have forfeited my right to consider myself a professional medical provider." And then go on with your life. Every patient has a right to have an ambulance come to them. Every patient has a right to a professional, thorough assessment, and every patient has a right to complete and competent treatment based on that assessment up to and including emotional support and pain management. Ok? As often happens you may think that I'm on the fence on this issue...I'll try and be more clear in the future... Dwayne Edited to repair formating.

Mazrin, Exceptional first post! Welcome to the City! I noticed that you're not naive about the whole 'glory and teary eyed thank yous' that is so commonly associated with entry level EMS people. Since you appear to have your feet on the ground, let's get right down to 'brass tacks': EMS can be a rewarding career. It's got its 'up sides' and its 'down sides'. A lot of people aren't burned out on the helping people aspect as much as they are on the bullshit that's associated. Depending on the service you're with, you've got: 1. Small vollie politics and ass kissing to get ahead 2. Clicques that you'll find any place you work 3. The "You're nothing more than a warm body in a uniform" mentality of some of the larger services 4. The "You're just a mere Basic, while I am a PARAGOD!" mentality of some of the levels of EMS 5. The 0300 "I've got to go to the ER for this stubbed toe!" call Then there's fighting the 'trauma junkie' mentality that is very pervasive in this field. The disappointment of not being able to 'save the world' because you've got your EMT-B, and have been turned loose with peoples lives in your hands. Depending on the call volume of the service you're on, you may or may not get breaks, you may or may not get 'sit down meals', and you may or may not be returned to quarters between calls. In GA, (and other areas of this great country) the average wage for an EMT-B is about $10.00/hr. By the time you factor in taxes and other expenses; no, you're not bringing home a lot of 'bacon' at the end of the week. Because of this, you start 'jumping open shifts' as they come available. This can lead to relationship problems because you're never around, and you're sleeping if you are. Another 'relationship hazard' is not being able to talk to your 'significant other' about the calls, because a) they won't understand a thing you're talking about or you're trying to shield them from the 'yucky stuff' we deal with in the field. EMS is demanding work, and it takes a special breed of person to be able to deal with all that we come across in the field. Many will tell you that once it 'gets in your blood', it's hard to get rid of the urge to 'jump in and take control of a bad situation'. A lot of EMT-B's get 'burned out' because they're relegated to the IFT trucks, where you're not always viewed as a health care provider, but more of a 'horizontal taxi cab'. Because of this, most people tend to lose sight of the fact that for any private service, the IFT is the 'bread and butter' of the company. They also tend to lose sight of the fact that on an IFT truck, you're getting a myriad of exposures to establish and hone your 'bedside manners' and really get your 'hands on' experience. Then there are those that go into EMS 'blind' until they are called to their first MCI and realize that this is NOTHING like they thought it would be and can't handle the patients screaming in pain. (Why does it always seem that the patients with the minor injuries scream the loudest and longest?) EMS is never a 'steady pace', it's either 'feast or famine'. The calls may be hours apart, or they may be back to back....it makes it difficult (especially with a volly or on call service) to make plans for anything. Sick and injured people don't take holidays off, and usually the 'low man on the totem pole' gets to pull all the holidays... Bottom line: EMS is a field that takes some 'tough as nails' individuals that can learn very quickly how to separate the 'business' from the private life. Many people can't do that, and they end up taking the job home with them. You have to be able to balance being compassionate to your patients, and being able to 'shut it off' at the end of the day. This ISN'T a good career choice for those that want to just do 'eight and skate', who can't leave work at work, and who are just too 'soft hearted'. It is also not a good 'fit' for those that complete EMT-B and think that they're at the top of their game. There is no 'top of your game' in EMS, because our patients rarely, if ever, read the textbooks and act accordingly.....

With out knowing the legal system and the rights granted to citizens in the United Kingdom, I can't answer this question exactly as posed. However, if the exact same situation occurred in the US, AND assuming that the fire itself did not pose a risk to others (this is independent of what was actually being burned), AND considering that this occurred in a public venue, than yes, I believe it's their right. I don't have to agree with the message given and I can personally pass judgment on the group, but that does not conflict with freedom of speech. Freedom of speech and assembly is not freedom from judgment of others, just undue government interference and regulation. They can destroy what ever pieces of their own property they want regardless of what meanings other people want to proscribe to to those objects provided they are not presenting a danger to others. Can I go burn a cross in my front yard? No, but because the fire is a danger to others. However nothing is stopping me from renting a wood chipper and throwing in as many religious symbols that I want. If I want to run a Koran, Bible, and Torah (to hit the 3 main monotheistic religions) through a shredder while standing on a street corner, I can. That doesn't mean others can't judge me on it though. As far as disruption, being in public it depends on how the disruption is occurring. Picketing, chanting, etc? Perfectly within their rights. Running on stage? Nope. However everyone in attendance is free to pass their own personal judgment on the jack wagons disrupting the event. What right do you have to proscribe what someone else does with their property because of the symbolism you proscribe to the object? If I believe that pencils are sacred, can I force you not to sharpen your pencil because I believe you are destroying it? Again, I don't know what rights the Citizens of the UK have under their government, which plays a big part in what the appropriate government response is. However, in my opinion and assuming similar rights to US citizens, the citizens have rights such as freedom of speech, freedom of press, etc. Non-citizens don't. This becomes a little hazy when it comes down to things like criminal trials and imprisonment, but that is drastically different than if a judge just unilaterally decided to deport a non-citizen. Additionally, having the legal right to do something doesn't mean free from the judgment of others. As with the above use of a wood chipper, I completely believe that I should be allowed to do so unfettered by the police. That doesn't mean that you can't come out and yell at me and treat me forever after as a persona non-grata. After all, that's your right to do so to. All actions have consequences, however not all consequences need to come from the government or agents of the government.

Acceptable and legal are two different questions. Acceptable? No. Something that should be illegal? Not if you value freedom of speech.

Interesting post, Spenac. I am of the mindset that as long as we (in general) keep accepting the option of providing a weekend class to the Basic so that he or she can do the job of the Paramedic, communities will always take the cheap way out and medics in the industry will never earn the money they could. Of course, this also ties in to the great debate of paid vs volunteer. To answer your questions specifically, I believe in using the tools we have to take care of our patients as needed and that includes pain management. I work in a rural area that has a high population of geriatrics where we see lots of falls. Why not relieve their pain prior to the move? Frankly, the use of an analgesic is as much for them as it is for me. The more calm calm the patient, the more calm the medic. As one person posted, "It's rare when I am truly able to save a life. But I have the opportunity to ease someone's pain on an almost daily basis. I'm not giving it away like I was a predator with candy or anything, but I have no fear or hesitation when it comes to easing my patient's pain. If you're on my box, and are a really in pain... baby you came to the right place!"

I can only speak for myself on this. I'm watching our customs, policies, rites, traditions, and observances slowly being eroded in the name of 'accomodation' of minorities...some who can't even be bothered to become citizens before they start demanding we change OUR ways to suit them. While we have no 'national religion', how is it that the minorities can expect their religious beliefs to be more important than those natural citizens of this country? How are our established policies, customs and practices suddenly 'less important' than those of the immigrating minority? How many of YOUR customs, traditions and religion are you willing to give up to make other's happy? Don't you have that RIGHT in this country as well as the minorities do? Where are YOU willing to 'draw that line' where you will not back up from? As a Catholic, I do not feel that my religion is better or superior to the Baptists, the Pentecostals, the Lutherans, the Buddhist, the Muslim, the Wiccan, the Scientologist or any other religious group, but I will NOT compromise MY religion to accommodate theirs as 'superior' or 'more important'! This country may only be a couple hundred years old, but guess what? Some of our traditions are that old as well, and 'thats the way we do things here'. To expect me to turn my back on over 200 years of traditions, customs, etc; just because you think YOUR ways are more important will probably meet with more than just a wee bit of resistance! The consitution states that 'all men are created equal' which to me means that no one person/group's ways of doing things should interfere, limit or otherwise negate the others! If you were to move to Iraq (as a matter of example) do you REALLY think you would be in a position to DEMAND that your traditions, religion and customs would be welcomed? I think the United States has been more than accomodating in that respect, and its about time that OUR ways of doing things are accomodated as well! It IS after all, OUR country that they came to!

Herbie, my condolences. This is an ode said by Aussies to remember our fallen, I hope it meas something to you as well FOR THE FALLEN With proud thanksgiving, a mother for her children England mourns for her dead across the sea, Flesh of her flesh they were, spirit of her spirit, Fallen in the cause of the free. Solemn the drums thrill: Death august and royal Sings sorrow up into immortal spheres, There is music in the midst of desolation And glory that shines upon our tears. They went with songs to the battle, they were young, Straight of limb, true of eyes, steady and aglow, They were staunch to the end against odds uncounted, They fell with their faces to the foe. They shall grow not old, as we that are left grow old: Age shall not weary them, nor the years condemn At the going down of the sun and in the morning We will remember them. They mingle not with their laughing comrades again, They sit no more at familiar tables of home, They have no lot in our labour of the daytime, They sleep beyond England's foam. But where our desires and hopes profound, Felt as a well-spring that is hidden from sight, To the innermost heart of their own land they are known As the stars are known to the night. As the stars shall be bright when we are dust, Moving in marches upon the heavenly plain, As the stars that are stary in the time of our darkness, To the end, to the end, they remain.

My own words would just seem so grossly inadequate, I hope these words would be more fitting ~Author Unknown~ maybe even help in the days to come, a poem in support of your family is my most sincerest prayer. Herbie: I and am very pleased that you would honour we as an EMT City brotherhood and share your pain, I know we ALL support you in this I have already said a prayer to my Great Spirit and my Guide. I most sincerely weep unmanly tears, but I am now making a toast to yet another fallen HERO. I now lift my glass ... it is time for final inspection SIR !

I actually came very close to doing an IO on drug OD some time ago. The call came in as a cardiac arrest, and when I got there, the patient was apneic with a pulse. The first-in medic had already given Narcan IM and of course they were bagging her. We did not see a vein anywhere, with both of us looking. She did not respond to the IM Narcan after quite some time into the call, so we gave it IN as well. I was expecting a quick response as from my past experience with IN's, but she did not respond at all and was still a 1/1/1 and apneic. I was about to do an IO when she finally began to respond. If I had not had this call, I would also have said that it seems overkill for a medic to do an IO on a drug OD, but there are situations where it is appropriate.

And never forget the exceptions that disprove the rule. Case in point for #31. Responded last winter for a 69 y/o M c/o sudden onset CP. Radiating to the L-arm and jaw accompanied by SOB, diaphoresis. Pt. had been shoveling snow when symptoms started. Hx of angina and prev. MI. Taken three sprays NTG w/ no relief. 12 lead showed clear ST-elevation in V2, V3, V4. No artifact or anything. We called for ACP back-up, administered ASA and 2 further sprays 0.4mg NTG. Pt. starts to drop his systolic as ACP back-up arrives. ACP starts a line, follows up with more NTG and fentanyl and takes over for transport. L&S to hospital bypassing ED right to cath lab. Pt. gets PCI for 90% occlusion LAD. Leaves hospital 3 days later. Sends a thank-you card just on time for Christmas. I practically expected to look over and see a prof with a clipboard.

also this

Ok, fine- I'll be the asshole. Why is it that the least experienced people always want to tell us what the "rules" of EMS are? Or the "you might be an EMT if..." crap, 90% of which they've only read about or seen on Turd Watch? Never understood it.